Research shows that children whose parents have mental illness are at risk of many poor social and behavioural outcomes such as poor school performance/attendance, out-of-home placements, problem-behaviour, poor relationship building and can even develop mental illness themselves. Even with the increasing interventions being developed for these children, they are still considered “invisible” or “hidden”. The situation is worse in Ghana where resource constraints in child welfare and mental health services are prevalent. For mental health services, there is often inadequate documentation about the parenting status of their patients. So, it becomes a challenge to reach the children and provide them with needed supports. Similarly, for child welfare services, they usually only come into contact with these children when mental illness interferes with parenting with reports of child abuse or neglect due to mental illness. A way to address the limited attention to the plights of these children, both in research and practice, is to prioritise their experiences and raise their concerns to be part of child welfare and mental health services provision. Using Bronfenbrenner’s ecological theory, this study was to offer a comprehensive understanding of what it is like to have a parent with mental illness in settings the children frequent. Settings of critical importance to these children that shaped their lives within the context of parental mental illness included the family, neighbourhood, school, church and the broader society.

Methodologically, the study was largely shaped by Husserl’s transcendental phenomenology. Emphasis was placed on phenomenological concepts of natural attitude, lifeworld, intentionality, inter-subjectivity and imaginative variation to make sense of the phenomenon “living with parental mental illness”. Data was collected in Ghana in the form of interviews and diaries with children (10 to 17 years) whose parents have mental illness. Thirty interviews and 19 diaries were completed. The children were recruited by contacting three out-patient psychiatric units in Ghana. All the children lived with a parent with mental illness. Parental diagnosis included schizophrenia, depression, psychosis and anxiety disorders. Following Husserl’s transcendental phenomenology, the data was analysed to get at the essence of the phenomenon “living with parental mental illness”. Interview data was managed with NVivo 12 qualitative software.

The essence of “living with parental mental illness” involves moments of sadness, uncertainty and hope. The children’s lifeworld emphasises the unpredictability that comes with having a parent with mental illness. The study found that ecological transitions and multi-setting participation often results in changes to the child’s perception of their situation. Across multi-setting participation and ecological transitions, children’s lifeworld was filled up with paradoxes. The paradoxes have been constructed in terms of the children’s interactions with parents in the family setting, relationships with peers and how they navigate the school. Life transition from family to school is originally positive and exciting. School can be a space of escape and reflection without having to think about parental mental illness. However, children’s loyalty and responsibility to parents with mental illness can at the same time distort the state of happiness they may enjoy once they move to the school setting. They are also torn between talking about parental mental illness with their peers or keeping silent. Talking to their peers about the parent’s mental illness could lead to stigma with attendant peer victimisation, but keeping silent could also mean psychological burden for themselves.

Results of the study have been used to make recommendations for practice within mental health and child welfare services in Ghana. Micro- and macro-level interventions and supports are required to break the unhealthy cycle created by the paradoxes. At the micro-level, a personal care plan has been developed through case management principles which incorporates the Family-Focused Framework with Kinship. The plan shows how social workers can work with other professionals like teachers, mental health nurses and psychologists to ensure that living with parental mental illness does not disrupt children’s lives at home, school and their peer relationships. At the macro-level, emphasis has been placed on promoting mental health literacy in schools and communities to deal with stigma. It is recommended that primary and secondary schools in Ghana include mental health literacy as a core curriculum content to provide students with non-stigmatising information about mental illness.